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In as much as March is Rabies Awareness Month, may we request you to write a primer on rabies, especially on how to prevent it? —This email address is being protected from spambots. You need JavaScript enabled to view it.

Rabies is a highly fatal viral disease that primarily affects warm-blooded animals other than man, notably dogs, cats, rats, and bats, but which can be transmitted to humans by infected animals. The rabies virus, which is present in the saliva of an infected animal, is passed to a human through a bite, or rarely, when the animal’s saliva gets in contact with a scratch or fresh break in the skin. Incidentally, humans can’t get infected with the rabies virus by eating the meat of a rabid animal, provided it is cooked.

The rabies virus primarily affects the central nervous system. The early symptoms of rabies in people are similar to those of many other infection—fever, headache, and general weakness or discomfort. As the disease progresses, more specific symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, salivation, difficulty in swallowing, and hydrophobia (fear of water).

There is no cure for rabies. In humans, once the clinical signs and symptoms of the disease have appeared, which takes two to eight weeks—sometimes longer—from the time of the animal bite, death invariably occurs within seven to10 days.

Rabies in the Philippines

Rabies is a serious public health problem in our country. The Philippines is among the top 10 countries with the highest incidence of rabies in the world. Department of Health (DOH) officials estimate that about 100,000 Filipinos are treated for dog bites and 200 to 300 die from rabies annually.

Among Filipinos, dogs account for 98 percent of rabies infection, cats account for the remaining two percent. An infected dog can transmit the rabies virus even before it becomes ill, but it will invariably manifest signs and symptoms of rabies including change in behavior such as unprovoked aggressiveness and excitability, paralysis, and hydrophobia within five days, and die within two weeks, after it gets infected.

Prevent rabies

Although there is no cure for rabies, it can be prevented. The key to rabies prevention is responsible pet ownership of dogs and cats. Responsible pet owners keep their pets’ vaccination for rabies up-to-date, restrict their pets within their homes or properties, and spay or neuter their pets to help reduce the number of unwanted pets that may not be properly cared for or vaccinated regularly. Spaying is the surgical removal of the reproductive organs of female dogs and neutering is the surgical removal of a male dog’s testicles.

Another important measure to prevent rabies is reporting stray dogs to the proper authorities. Removing stray dogs is important because these animals may be unvaccinated or ill.

In case of a dog or cat bite

Wash the wound immediately with soap and water then bring the victim to a doctor or to the nearest Animal Bite Treatment Center for post exposure prophylaxis treatment. This treatment consists of a single dose of human rabies immune globulin and several doses, some days apart, of rabies vaccine, all given in the form of injections. In addition, if the wounds are deep and the victim has no immunization against tetanus, tetanus serum, and toxoid injections have to be administered, too. Home medications consisting of a course of antibiotics may also be necessary for deep and/or dirty wounds.

If the biting dog or cat has been apprehended, do not kill it. Place it in a cage and observe it. Unusual behavior or death of the animal is presumptive evidence of rabies. Alternately, you can bring the animal to a properly equipped center where it can be “put to sleep” and its brain examined for rabies. One such center is the Regional Institute of Tropical Medicine (RITM) in Alabang, Muntinlupa City.

Diabetes imposes a heavy physical and socioeconomic burden on the patient, his/her family, and on society. Patients with advanced diabetes may have frequent trips to the hospital emergency room (ER), and may require confinement due to heart failure (HF) symptoms.

That’s why we usually instruct resident doctors assigned to the ER that when a known diabetic complains of shortness of breath or difficulty of breathing when exerting effort or when lying down, there might be an underlying heart problem, which requires further tests.

Although usually there’s heart enlargement (cardiomegaly) when HF is present, some diabetics may present with a type of HF in which the heart size may still be normal.

This is called diastolic HF, in contrast to systolic HF which usually presents with an enlarged heart.

Diastolic HF, which may be seen in patients with diabetes, hypertension and when there is thickening of the heart muscles (hypertrophy), is due to stiffness of the heart. It should relax during the second phase of the heart contraction called diastole, but in diastolic HF, it remains partially stiff, which can impair the contraction or pumping action of the heart.

Furthermore, it compresses the heart arteries supplying nutrition to the heart, which may render a portion of the heart muscles lacking in oxygen and nutrients, an imbalance of the circulation called ischemia.

For decades, the challenge to physicians treating diabetic patients was how to remedy this imbalance and prevent hospitalization due to HF.

Reduced hospitalization rate

A new study, presented at the American College of Cardiology (ACC) scientific sessions in Washington DC last week, showed that a relatively new class of drugs called sodium glucose cotransporter-2 inhibitor (SGLT-2i) can reduce the rate of hospitalization for diabetic patients and could even prolong life.

This confirms the findings of a landmark trial (Empa-Reg outcome trial), published two years ago, which also showed that a member of this class of drugs (empaglifloxin) can reduce deaths from any cause, heart-related deaths, and hospitalization for HF.

In the present real-world study across six countries in Europe and the United States, researchers looked at the outcomes between treatment with a SGLT-2i and other glucose-lowering drugs (oGLD), in terms of hospitalization for HF (HHF).

Dr. Mikhail Kosiborod presented the paper in the conference, attended by close to 30,000 heart specialists and scientists from all over the world, who braved the subzero temperature outside.

The patient records of 364,828 diabetic patients were analyzed, evenly representing both treatment groups. The mean age was 57 years old, and 56 percent were men. At baseline, 3 percent had HF, 13 percent had established cardiovascular disease mainly of the heart, brain and leg arteries; while 27 percent had small-vessel disease like eye, nerve and kidney problems.

The researchers reported that there was a reduction that favored the SGLT-2i in each of the six countries involved in the study.

Furthermore, in the SGLT-2i treated group, there was a lower death rate from any cause. They used statistical analyses, suggesting that the differences in both HHF and all-cause death were not due to chance or to any bias, either on the doctor’s side or patient’s side.

Usually, doctors require a more stringent design of clinical research called randomized controlled trial (RCT) in which both patients and doctors don’t know (double-blinded) what type of treatment all patients are receiving.

But considering the huge number of patients in this study by Dr. Kosiborod’s group, I would personally put some weight to the study findings.

In short, the fear of a shortened life span of diabetics due to heart complications, particularly heart failure, seems to have found its therapeutic match.

In addition to other life-extending medicines like cholesterol-lowering drugs (statins), blood thinners like aspirin, and artery-friendly drugs like angiotensin converting enzyme inhibitors or angiotensin receptor blockers, it’s not too remote that, soon, diabetics can finally take away the cardiovascular sword of Damocles hanging over their head.

Prof. Xu Kecheng, a renowned specialist in gastroenterology, hepatology, and cancer treatment, and founder of the Fuda Cancer Hospital, was diagnosed with a rare and often fatal liver cancer 11 years ago. From being the brave doctor, helping others fight their bruising battles against cancer, he’s now the patient, facing the Big C himself. After undergoing surgery, he was surfing the Internet when he came across an article by a doctor from Taiwan who reviewed 81 patients who got hepatectomy, of whom only 11 survived more than five years. He read that these patients who had cholangiocarcinoma (like him) could receive “adjutant chemotherapy with medium survival time one to three months longer than the control group without chemo.” But he told himself, if spending the next few months of his life meant vomiting, losing his hair, losing sleep, and suffering all those painful side effects of chemotherapy, he didn’t think he wanted it.

In an article he wrote titled “What we can do when chemotherapy fails,” he points out that “chemo induces genetic mutation of cancer cells, leading them astray, which makes those cells not only immune to chemotherapy drugs but also more malignant.”

The good doctor, who has gained a lot of following, also authored the book, yes, Follow Me to Fight Against Cancer. So, now, let’s follow Dr. Xu as he gives some answers to some questions on cancer in this interview with The Philippine STAR.

DR. XU KECHENG: We treated a patient with hepatocellular carcinoma. The patient had an 18cm tumor. He was told that he had three months to live. He went to Fuda for treatment and was given trans arterial chemo embolization (embolic particles with chemotherapeutic drugs injected to the artery supplying the tumor), brachytherapy, also known as iodine seed implantation (the seeds are placed inside needles and inserted to the masses, giving a dose of radiation), cryosurgery, and oral chemo tablets.

We also treated a patient suffering from liver cirrhosis with liver cancer. The patient had systemic chemo and radiotherapy while in the Philippines. He was told he had two weeks to live. By the time he went to Fuda, he was suffering from jaundice. He had IV infusion to improve the liver function, bile duct stenting, brachytherapy, trans arterial chemo embolization, and immunotherapy.

Are there more male patients with liver cancer than women?

In Fuda, there are more male patients with liver cancer mainly because of their lifestyle. They are highly stressed, their alcohol intake is very high, and most of the time, they lack sleep.

Why do cancer cells metastasize even when the patient is already undergoing chemotherapy?

Cancer patients in the Philippines often receive systemic chemotherapy. This type of chemotherapy attacks even the good cells, which weakens the immune system of the body. Also sometimes, the diagnosis is incomplete. In Fuda, after the biopsy, we often recommend a gene mutation test.

Based on your own experience, does chemotherapy really prolong a patient’s life? And how long?

Yes, it can prolong a patient’s life. However, chemotherapy alone is not enough. We recommend that patients go through immunotherapy as well.

If chemotherapy fails, what’s the next thing a patient should do?

In Fuda, during the initial stage of the cancer disease, we recommend targeted treatments like Nano Knife and cryosurgery. Nano Knife destroys tumors with electric current while cryosurgery destroys tumors through freezing.

We also perform targeted chemotherapy treatment, which is different from systemic chemotherapy. In Fuda, the chemo drug is infused to the artery leading to the cancer tumor. Targeted chemo does not kill the good cells.

Chemotherapy is still an effective way to treat cancer, the main problem is the side effects. Systemic chemo kills the good cells and lowers the immune system, thereby weakening the body. Intervention chemo or targeted chemotherapy does not kill the good cells because it is infused straight to the artery leading to the cancer tumors.

If not chemo, what would you recommend for early or advanced cases of liver cancer?

In Fuda, we normally treat liver cancer using cryosurgery, brachytherapy, and immunotherapy.

How does this treatment work?

In cryosurgery, a cryo probe is inserted to the tumor. It releases argon, allowing the formation of an ice ball that covers the tumor. Once frozen, helium is injected to increase the temperature and remove the blood supply to the tumor.

In brachytherapy, the seeds are placed inside needles and inserted to the mass, giving a dose of radiation.

In immunotherapy, patients are given a vaccine that can eliminate the cancer cells. Cells from the resected mass are isolated and cultured to build their tumor-killing capabilities, and are injected back to the body.

What’s the best way to make our cells healthy and fight cancer? To boost our immune system against disease?

I always advise patients to avoid sugar. Sugar is the food of the cancer cells, it strengthens cancer cells.

What anti-cancer foods can you recommend?

You can eat anything but in proper moderation. Follow the food pyramid.

Just a few days ago, I narrated the story of a patient of mine with Kaposi’s Varicelliform Eruption (KVE). Got overwhelming reactions, predominantly apprehensions about having herpes infection. Which is why I’m writing this, to alleviate fears about this virus. Herpes Simplex Virus (HSV) has a vast presence in humans. Actually, it is not that scary. In fact, some 80 to 90 percent of humans experience oral herpes infections by 10 years old, mostly through casual contact. It becomes scary only if you have other conditions such as immunosuppression or atopic dermatitis.

Herpes Simplex Virus (HSV) is quite common in humans. Many will have an acute episode manifesting as infected gums and lips, causing high fever, but most apparently have few, if any, symptoms. A substantial portion of the population has recurrent oral herpes infection, showing up as those nuisance little “cold sores” on lips and sides of the mouth, and occasionally elsewhere on the face.

Herpes Simplex Virus (HSV-1) causes about 80 percent of cases of oral herpes infections. In addition, skin contact with the lesions on an infected individual can spread the disease to another individual. Transmission is generally via respiratory droplets (HSV-1) or direct contact (HSV-1 and HSV-2). Simply stated, HSV-2 is primarily sexually transmitted, so it is less common than HSV-1. The virus of Herpes Simplex Virus 1 can be transmitted most easily through saliva but can also be passed on through respiratory droplets and from mucosal contact with someone shedding the virus even though that person is asymptomatic or has no symptoms.

Where is herpes found?

Herpes infects the nerve cells of the spinal cord near the pelvis (in the setting of genital herpes) and of the nerve ganglia serving the face at the base of the brain (in the setting of oral herpes). Herpes is a DNA-type virus, inserting its DNA directly into the dendritic nerve endings of the skin, which then leads along nerve fibers to the nucleus of the nerve cell. Once the viral information is inserted into the cell’s nucleus, this blending of viral genetic information with human genetic information is permanent. The nerve cell then becomes a factory for making more viral particles.

Genital herpes and oral herpes refer to the location where the herpes infection is found in the individual. Most genital herpes are caused by HSV-2, but can be caused by HSV-1 in as many as 30 percent of new cases because of individual sexual practices. Oral herpes is most often caused by HSV-1, and only rarely by HSV-2. Because these locations are often associated with a particular type of herpes (which seems to take hold in those particular locations more easily), medical people, websites, and literature often equate the location with the herpes type. You might find that people speak of genitally located herpes infections as HSV-2 and orally-located herpes as HSV-1. However, humans can have either virus in either place, and in fact, potentially anywhere on the body.

For discussion’s sake, I will call genital herpes infection “GHI” and oral herpes infection “OHI.” Generally, GHI is not considered to be extremely contagious. Casual contact on toilet seats, chairs, and similar sorts of workplace contact are almost certainly non-contagious, though this is debatable. Anecdotal case reports of persons acquiring GHI through contact in hot tubs have been published. Obviously, such matters would be very difficult to verify. The herpes virus does not survive outside the body for more than about 10 seconds, and although it can survive for slightly longer in warm, damp conditions, it dies very quickly once exposed to the air.

However, GHI is contagious, typically through skin-to-skin contact with an infected area. The method of transmission may occur through an active herpes blister on one person to a broken area of skin on the other person. For example, a male with an open blister could transmit the virus to the vagina of a female through a tiny abrasion in the vaginal mucosa of the female that could occur during intercourse. Similar modes of transmission can occur from female to male, male to male, and even female to female. Oral-to-oral transmission of either type of virus can also happen.

The virus may be transmitted to the penis, the vagina, the rectum, the mouth, and more rarely, the esophagus, the trachea, and even onto broken areas of skin anywhere on the body. Herpes simplex pneumonias have also been reported. And, of course, herpes simplex infections of the brain in newborn babies who acquire infection during delivery are well known, too, and can be medical disasters. About one in three cases of Herpes Virus Encephalitis (HSE) results from primary HSV-1 infection, predominantly occurring in individuals under the age of 18. HSE is thought to be caused by the retrograde transmission of virus from a peripheral site on the face, following HSV-1 reactivation, along a nerve axon, to the brain. Herpes simplex may also cause widespread rashes on the body with redness and swelling in these areas, reminiscent of measles. Again, once the viral DNA has been transmitted to the receiving person’s nerve cells, the infection is permanent.

Finally, many people with GHI (and probably OHI as well) produce viral particles even when they have no symptoms at all and are likely to be contagious. This is called “asymptomatic shedding.”

It is vital to realize that viral shedding can occur from people who have acquired the infection asymptomatically. This means that people can be infected and that only their blood tests might be positive. That they may have no symptoms or few symptoms that are recognized as being caused by herpes, and yet they may still be shedding virus and may therefore be contagious.

Kids exposed to high levels of lead decades ago may now be approaching middle age with lower IQs and earning potential than they would have had otherwise, a new study suggests.

These days, doctors warn parents that there’s no safe level of lead exposure. This toxin can damage the developing nervous system in young children, and blood lead levels as low as 5 micrograms per deciliter may lower intelligence quotient (IQ), according to the World Health Organization.

Participants in the current study had average blood lead levels more than twice that high when they were 11 years old in the early 1980s: 10.99 micrograms/dl.

Every 5 microgram/dl increase in blood lead levels early in life was associated with a 1.61-point lower IQ by the time these children reached age 38, as well as reductions in perceptual reasoning and working memory, researchers report in JAMA.

“This suggests at the very least that individuals don’t fully recover from lead-related cognitive injuries received in childhood,” said lead study author Aaron Reuben of Duke University in Durham, North Carolina.

“It also suggests that lead exerts a downward pull on an individual’s cognitive abilities over time regardless of where they start out in life,” Reuben said by email.

For the study, researchers examined data on cognitive function, IQ and socioeconomic status for 565 adults in Dunedin, New Zealand when they were 38 years old, as well as results from blood tests for lead done in childhood.

Childhood blood lead levels ranged from 4 to 31 micrograms/dl.

There were no meaningful differences in lead exposure based on socioeconomic status, and elevated blood lead levels were found in children from poor and affluent families alike.

Participants with childhood blood lead levels above 10 micrograms/dl had average adult IQ test scores 4.25 points lower than their peers with lower blood lead levels.

After accounting for factors that can influence adult IQ and earnings such as childhood IQ and socioeconomic status as well as mothers’ IQ, researchers still found that higher lead levels in childhood were tied to what’s known as downward social mobility, or adult kids earning less or having less prestigious jobs than their parents.

“The normal trend for this generation is for sons and daughters to achieve better occupations than their parents,” said senior study author Terrie Moffitt, also of Duke University.

“But among those with elevated lead levels the trend was opposite,” Moffitt said by email. “Much of this could be attributed to the IQ effect.”

Some previous research has linked each 1-point decrease in IQ scores to $200 to $600 less in annual income, Moffitt said. The average 4.25-point lower IQ scores tied to high lead exposure in the study could translate into a net worth reduction of several thousands dollars, Moffitt said.

While lead exposure has long been linked to poor academic achievement, this study offers fresh evidence of how high blood lead levels in childhood could lead to lower socioeconomic status in adulthood, said David Bellinger, a researcher at the Harvard T.H. Chan School of Public Health in Boston and author of an accompanying editorial.

“Effects on IQ are just the tip of the iceberg,” Bellinger said by email. “The adverse effects extend far beyond, to include impaired attention, including ADHD, impairments of executive function, and different forms of social pathologies - impairments that are likely to be more important in determining an individual’s success in life than a modest reduction in IQ.”

In some cities in the states of New York, Ohio and Pennsylvania, at least one in seven kids have unsafe levels of lead in their blood, a study released last June in the Journal of Pediatrics found.

A Reuters investigation of blood testing data in California also found dozens of communities had rates of unsafe childhood lead exposure that surpass those of Flint, Michigan (reut.rs/2o40nKc). In one zip code in Fresno, California, 13.6 percent of blood tests on kids under age 6 came back high for lead. That compares to 5 percent across the city of Flint during the recent water contamination crisis there.